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Florida rates for HCPCS L3961

Shoulder-elbow-wrist-hand orthosis (SEWHO), shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$767.44 / $850.49 / $974.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.94 / $895.25 / $1,621.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,028.38 / $1,028.38 / $1,028.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$750.72 / $750.72 / $1,028.38
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99,999.99 / $99,999.99 / $99,999.99
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$835.21 / $1,337.13 / $1,852.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,481.82 / $1,481.82 / $1,481.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$723.55 / $904.81 / $1,177.92
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,002.36 / $1,002.36 / $1,852.28